Tuesday, December 24, 2013

Aspirin to treat aggression? The evidence isn't there yet

Aspirin to treat aggression? The evidence isn't there yet
Headlines claiming aspirin can treat 'intermittent explosive disorder' are going beyond the evidence available, and might even put people at risk
Friday 20 December 2013
Regular aspirin use can increase the risk of bleeding in the brain or stomach, and there’s not enough evidence to advise healthy people to take it daily. Photograph: Alamy

The Telegraph front page on Thursday reported that aspirin could be a cure for intermittent explosive disorder. IED, characterised by bouts of extreme and disproportionate rage, is thought to affect 2-3% of the population of the USA, according to the research paper.

It’s a pretty serious disorder, not to be confused with mere ‘bad behaviour’. These are impulsive, hard-to-control aggressive outbursts, and the condition is linked to a number of other adverse health outcomes.

But can aspirin really cure it? I went to the study in question and had a look. For a start, there’s no mention of aspirin, or any anti-inflammatory drug, anywhere in the peer-reviewed article.

The scientific research looks at the relationship between aggression, in particular IED symptoms, and levels of two inflammatory markers found in blood plasma – C-reactive protein, and interleukin 6. The study is a case-control design, which means people are chosen to be included in the study because of their aggression status.

They recruited fewer than 200 people, which for studies of this design is quite a small number, and then further split these people into three groups to compare. People with IED are likely to be different from people without it in a number of ways, so usually for observational studies like this you’d want a larger sample size.

Not only this, but the measures of aggression and the measures of inflammatory marker levels were taken at the same time as each other. This means that even if an association between the two is seen, as it was here, there is no way of knowing the direction of causation.

Aside from the possibility that the association seen is due to other differences between people with or without IED, it could be that aggression leads to rises in inflammatory markers, or that increases in these markers lead to an increase in IED. If the former is true, then no amount of aspirin would help, as causation is the wrong way round.

Which brings me to my next question: can aspirin actually change the levels of these markers? Evidence suggests not. The main marker investigated is C-reactive protein (also known as CRP). Because it is relatively easy to measure, and stability in level, it’s often used as a marker of inflammation, with rises in levels associated with diseases such as diabetes, cardiovascular disease and potentially even some cancers.

However, there’s very little evidence that aspirin can change levels of CRP. Although this study suggests that aspirin might differentially affect risk for unstable angina depending on CRP levels, the levels themselves weren’t greatly affected by aspirin use. Other studies have found no effect on CRP levels after aspirin use.

Also, it’s important to remember that aspirin is not a harmless drug. In fact a recent review suggests that for healthy people, there’s not enough evidence that the potential benefits would outweigh the risks of daily aspirin. Regular aspirin use can increase health risks such as bleeding in the brain or stomach, and as yet there’s not enough evidence to advise healthy people to take aspirin as regularly as daily.

For a newspaper to suggest that aspirin could treat this disorder, a claim that wildly extrapolates from the findings they are referring to, is not only misleading in terms of the findings of the research, but also potentially could harm people who might think they should begin self-medicating with aspirin.

Bayer AG
Bayer AG
Bayer AG (/ˈbaɪər/; German pronunciation: [ˈbaɪ̯ɐ]) is a German chemical and pharmaceutical company founded in Barmen (today a part of Wuppertal), Germany in 1863. It is headquartered in Leverkusen, North Rhine-Westphalia, Germany and well known for its original brand of aspirin. Bayer marketed heroin in 1895 and invented aspirin in 1897. The company was 150 years old on 1 August 2013.
The Bayer company then became part of IG Farben, a German chemical company conglomerate. During World War II, the IG Farben used slave labor in factories attached to large slave labor camps, notably the sub-camps of the Mauthausen-Gusen concentration camp.[3] IG Farben owned 42.5% of the company that manufactured Zyklon B,[4] a chemical used in the gas chambers of Auschwitz and other extermination camps. After World War II, the Allies broke up IG Farben and Bayer reappeared as an individual business. The Bayer executive Fritz ter Meer, sentenced to seven years in prison during the IG Farben Military Tribunal at Nuremberg, was made head of the supervisory board of Bayer in 1956, after his release.

Note: Klaus Kleinfeld is a director at Bayer AG, a trustee at the Brookings Institution (think tank), a director at the American Friends of Bilderberg (think tank), and a 2008 Bilderberg conference participant (think tank).
Foundation to Promote Open Society was a funder for the Brookings Institution (think tank), and the Committee for Economic Development.
George Soros is the chairman for the Foundation to Promote Open Society.
Robert A. Helman was an honorary trustee at the Brookings Institution (think tank), is a partner at Mayer Brown, and a member of the Commercial Club of Chicago.
Commercial Club of Chicago, Members Directory A-Z (Past Research)
Tuesday, December 17, 2013
William M. Daley was a partner at Mayer Brown, the chief of staff for the Barack Obama administration, and is a member of the Commercial Club of Chicago.
William M. Daley
Professional career
Daley returned to the practice of law, as a partner with the firm Mayer Brown (then Mayer, Brown & Platt) from 1993 to 1997.
Mayer Brown was the lobby firm for the Bayer Corporation.
Bayer Corporation is the North American subsidiary of Bayer AG.
Bayer HealthCare is a subsidiary of Bayer AG.
Sidley Austin LLP is the lobby firm for Bayer HealthCare.
R. Eden Martin is counsel at Sidley Austin LLP, and the president of the Commercial Club of Chicago.
Michelle Obama was a lawyer at Sidley Austin LLP.
Barack Obama was an intern at Sidley Austin LLP.
Newton N. Minow is a senior counsel at Sidley Austin LLP, and a member of the Commercial Club of Chicago.
W. James McNerney Jr. is a member of the Commercial Club of Chicago, and the chairman & president & CEO for the Boeing Company.
Barbara G. Fast was a VP at the Boeing Company, and a VP for the CGI Group Inc.
CGI Group Inc. was the Obamacare contractor that developed Healthcare.gov web site.
Obamacare is Barack Obama’s signature policy initiative.
Donna S. Morea was the EVP for the CGI Group Inc., and a trustee at the Committee for Economic Development.

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